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What does it mean to be 'sleepy'?

SASSOWER

With National Sleep Awareness Week quickly approaching April 23-29, Kenneth Sassower, MD, neurologist in the Sleep Disorders Unit, answers the most commonly asked questions about sleep, and shares his most important piece of advice.

Are sleep issues the same in children as in adults?There are some very distinctive differences between children’s sleep and adult sleep. Adults become sleepy because they’re sleep deprived, but that’s not the case with children. Some problems with pediatric sleep are attention and behavioral disturbances and parasomnias (sleep walking and night terrors).

What does it mean to be ‘sleepy’?Sleepiness can be drowsiness that affects daytime functioning. It also can manifest in daytime naps and feeling the need to nap. It could mean going to Starbucks a lot to keep yourself awake or a combination of all those things.

Is being ‘fatigued’ the same as being ‘sleepy’?Fatigue refers to being more tired and exhausted, not necessarily sleepy. It might mean a lack of energy, a lack of inspiration or when someone doesn’t feel like doing anything. Signs of fatigue include loss of exercise capability and endurance and may co-exist with sleepiness. Causes of fatigue could be a circadian rhythm sleep disorder, neuromuscular and mitochondrial disorders, anemia, cardiac or chronic lung disease, rheumatologic or endocrinologic disease or a psychiatric condition.

What are the most common sleep symptoms?Out of all the symptoms of patients who come into our office the most common are insomnia, excessive daytime sleepiness and disturbed behavior during sleep. Patients can go years without knowing they have a disturbed sleep behavior because they do not have partners to inform them.

Is there an actual way to measure sleepiness?Yes. There are several diagnostic tools, but the most commonly used method is the Epworth scale used often in the MGH Sleep Lab. This method uses about six questions that suggest how likely a patient is to fall asleep in certain scenarios: If the patient is speaking to someone or driving a car, among other things. Other tools used to diagnose sleepiness are sleep diaries, performance tests and neurophysiologic tests.

What does Attention Deficit Disorder (ADD) have to do with sleep?There is an area of the brain called the prefrontal cortex. If there is an injury to that part of the brain, someone will become inattentive. It could be due to a structural reason, or a physiological reason. There is a very fine line between being relatively sleep-deprived and being inattentive, according to studies. If someone is in a lecture hall and becomes sleepy, there’s no way they’ll be able to pay attention. Paying attention is not a function that one can easily perform if they are sleepy. Often in our office we see patients who are inattentive as a result of being too sleepy. In addition, if you’re sleep deprived and you have underlying ADD, it may make it worse.

"The best piece of generic advice I could give, and this is the most important: Try to go to bed at the same time and get up at the same time, every day." --Kenneth Sassower, MD, neurologist in the Sleep Disorders Unit

What does autism have to do with sleep?Autism and sleep disorders seem to co-exist. There have been several studies about the prevalence of sleep issues in those with autism and the numbers are staggering. Up to 83 percent of kids with autism have some sort of sleep dysfunction, as opposed to 10 to 30 percent of kids who are otherwise typically developing. Autism is becoming so much associated with sleep issues that people are proposing that perhaps autism should be defined in the terms of some sleep issues. If you take 100 children who have some form of generalized developmental disability and you take 100 children with autism and you put them to sleep, the 100 children with a developmental disability will sleep. The children with autism will be up and down all night, and it can become a family issue. If there is a child on the spectrum who isn’t sleeping, that means the family isn’t either.

What are the most common causes of daytime sleepiness?The most common cause of daytime sleepiness, without question, is inadequate sleep hygiene. Sometimes people drink too much coffee, or they have a glass of wine and while they initially fall asleep, they wake up in the middle of the night and can’t get back to sleep. We have to bear in mind that some people might be sensitive to certain things, like caffeine, and even if you have a cup of coffee in the morning, it might affect how one sleeps.

What are the most common intrinsic (part of the anatomy) sleep disorders?Some of these disorders are sleep apnea, periodic limb movements of sleep and restless leg syndrome (RLS). RLS is when you feel like you have to move your legs. Other disorders include a non-REM parasomnia – such as sleepwalking – or a REM parasomnia such as REM behavior disorder. There are also conditions that cause excessive daytime sleepiness – such as narcolepsy or idiopathic hypersomnia. In narcolepsy, people suffer from very vivid dreaming, acute sleep attacks, sleep paralysis and an acute loss of motor tone in association with emotions. With idiopathic hypersomnia, you may feel as if you can’t get enough sleep. With this disorder someone could be sleeping 12 to 18 hours per day, yet still feel exhausted; it can be very debilitating.

What are the most common extrinsic (not having to do with our internal mechanism) sleep issues or sleep disorders?Inadequate sleep is the most prevalent sleep issue. Common complaints about inadequate sleep hygiene are trouble falling asleep, difficulty staying asleep, not getting enough sleep, unrefreshing sleep or needing sleeping pills to fall asleep. Some medications can cause insomnia, for example, asthma medicines (bronchodilators), have an activating effect. Some conservative treatment guidelines would be having a consistent sleep time; avoid daytime naps; eliminate late afternoon caffeine use; reduce or eliminate tobacco use; avoid evening exercise if you can; keep the bedroom dark, quiet and cool; avoid computers, laptops, iPads and phones; and use the bedroom only for sleep. The best piece of generic advice I could give, and this is the most important: Try to go to bed at the same time and get up at the same time, every day.